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Organization
TIMBER LAKE AMBULANCE SERVICE INC
Active
Organization
TIMBER LAKE AMBULANCE SERVICE INC
Active
Other names
TIMBER LAKE AMBULANCE SERVICE
Organization subpart
No
Provider details
NPI number
Authorized official
MISS CHRIS HERMES (TREASURER)
(402) 572-4019
Entity
Organization
Contact information
Practice address
900 MAIN ST, TIMBER LAKE, SD 57656
(402) 572-4019
(402) 965-8594
Mailing address
PO BOX 641880, OMAHA, NE 68164-7880
(402) 572-4019
(402) 965-8594
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
0243
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0099213
BLUE CROSS PROVIDER
SD
01
—
590014108
RR MEDICARE PROVIDER
—
05
—
9017020
—
SD
Enumeration date
06/27/2006
Last updated
04/29/2009
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